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Review
. 2023 May;29(5):877-887.
doi: 10.3201/eid2905.221294.

Trends in and Risk Factors for Recurrent Clostridioides difficile Infection, New Haven County, Connecticut, USA, 2015-2020

Chinenye M Okafor, Paula Clogher, Danyel Olson, Linda Niccolai, James Hadler
Review

Trends in and Risk Factors for Recurrent Clostridioides difficile Infection, New Haven County, Connecticut, USA, 2015-2020

Chinenye M Okafor et al. Emerg Infect Dis. 2023 May.

Abstract

Recurrent Clostridioides difficile infection (RCDI) causes an increased burden on the healthcare system. We calculated RCDI incidence and identified factors associated with RCDI cases in New Haven County, Connecticut, USA, during 2015-2020 by using data from population-based laboratory surveillance. A subset of C. difficile cases had complete chart reviews conducted for RCDI and potentially associated variables. RCDI was defined as a positive C. difficile specimen occurring 2-8 weeks after incident C. difficile infection. We compared cases with and without RCDI by using multiple regression. RCDI occurred in 12.0% of 4,301 chart-reviewed C. difficile cases, showing a U-shaped time trend with a sharp increase in 2020, mostly because of an increase in hospital-onset cases. Malignancy (odds ratio 1.51 [95% CI 1.11-2.07]) and antecedent nitrofurantoin use (odds ratio 2.37 [95% CI 1.23-4.58]) were medical risk factors for RCDI. The 2020 increase may reflect the impact of the COVID-19 pandemic.

Keywords: CDI; Clostridioides difficile; Connecticut; United States; antimicrobial resistance; bacteria; bacterial infections; chronic disease epidemiology; malignancy; nitrofurantoin; nosocomial infections; recurrent CDI; recurrent Clostridioides difficile.

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Figures

Figure 1
Figure 1
Annual incidence rates of Clostridioides difficile infection (CDI) (A) and recurrent CDI (B), New Haven County, Connecticut, USA, 2015–2020. CDI cases were all reported CDI cases in New Haven County. Recurrent CDI cases were available only for cases with complete chart reviews.
Figure 2
Figure 2
Annual incidence rates of Clostridioides difficile infection (CDI) (A) and recurrent CDI (B), by epidemiologic class, New Haven County, Connecticut, USA, 2015–2020. Recurrent CDI cases were available only for cases with complete chart reviews. Epidemiologic class of incident cases was not available for 74 cases because medical records were not available. CA, community-associated; CO-HCFA, community-onset healthcare facility–associated; HCFO, healthcare facility–onset.
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